Hypertensive disorders of pregnancy linked to subsequent atrial fibrillation

Women who had hypertensive disorders of pregnancy (HDP) during their first delivery face an increased risk of incident atrial fibrillation (AF), particularly those who had more severe de novo HDP diagnoses as well as chronic hypertension in pregnancy, according to a retrospective study.

For the study, researchers looked at 771,521 nulliparous women (median age at first delivery 29 years, 3.4 percent had polycystic ovary syndrome) discharged for obstetrical delivery of their first live or stillborn singleton infant. They analysed the participants’ medical data, which were obtained from linked population-based administrative databases.

During the 16-year exposure accrual period, roughly 8 percent of the participants received a diagnosis of HDP. The most common diagnosis was gestational hypertension, while the least common was eclampsia. Close to 5 percent of the participants had incident chronic hypertension in the postpartum period during the follow-up. This was especially prevalent in those who had gestational hypertension (16 percent) and pre-eclampsia (14 percent) in their index delivery.

A total of 2,483 (0.3 percent) incident AF diagnoses and 2,951 (0.4 percent) deaths were recorded over 7,380,304 person-years of follow-up. History of any HDP emerged as a risk factor for incident AF (adjusted cause-specific hazard ratio [HR], 1.45, 95 percent confidence interval [CI], 1.28–1.64) and death without a previous AF diagnosis (adjusted cause-specific HR, 1.31, 95 percent CI, 1.16–1.47). These associations were pronounced in relatively young women (median time to event, 7 years postpartum).

Of note, a dose-response relationship was observed, with more severe HDP subtypes and prepregnancy chronic hypertension correlating with a 1.5- to 2.2-times higher cause-specific rate of AF and a 1.4- to 2.1-times higher cause-specific rate of death when compared with no hypertension in pregnancy.